Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve
Background Valve-related haemolysis is a known complication following prosthetic valve surgery. Haemolysis after transcatheter aortic valve implantation (TAVI) has been reported in some studies, all of which were non-critical. Data related to haemolysis associated with new-generation balloon-expanda...
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BMJ Publishing Group
2025-01-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003112.full |
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| author | Mitsuaki Isobe Mitsunobu Kitamura Mamoru Nanasato Itaru Takamisawa Ryosuke Higuchi Makoto Ohno |
| author_facet | Mitsuaki Isobe Mitsunobu Kitamura Mamoru Nanasato Itaru Takamisawa Ryosuke Higuchi Makoto Ohno |
| author_sort | Mitsuaki Isobe |
| collection | DOAJ |
| description | Background Valve-related haemolysis is a known complication following prosthetic valve surgery. Haemolysis after transcatheter aortic valve implantation (TAVI) has been reported in some studies, all of which were non-critical. Data related to haemolysis associated with new-generation balloon-expandable valve (BEV) are scarce.Methods Among 441 patients who underwent TAVI between April 2023 and June 2024, 282 patients treated with new-generation BEV were analysed. Haemolysis was defined based on the lactate dehydrogenase, haemoglobin, reticulocyte and haptoglobin levels. Clinically relevant haemolysis was defined as a case requiring transfusion and/or reintervention.Results Clinically relevant haemolysis occurred in 6 of 282 patients (2.1%), with median age of 84 years. Three (50%) received a 20 mm valve, and the oversizing ranged from −6.6% to +2.7%. All patients (100%) exhibited paravalvular leakage at the native commissural sites, with moderate or greater paravalvular leakage in two (33%). Lactate dehydrogenase levels exceeded 1200 IU/L in five (83%), four (67%) required transfusion and three (50%) underwent reintervention: balloon aortic valvuloplasty in one and valve-in-valve procedures in two. Haemolysis regressed in three reintervention cases; however, one patient died 9 days postoperatively due to COVID-19. Among three patients (50%) managed conservatively, one developed prosthetic valve endocarditis, whereas another showed spontaneous regression of haemolysis. Over a median follow-up of 218 days, five patients (83%) survived.Conclusion Clinically relevant haemolysis occurred in 2.1% of patients undergoing TAVI with new-generation BEV, with 67% requiring transfusion and 50% undergoing reintervention. Further research is warranted to identify risk factors and optimise management strategies for haemolysis. |
| format | Article |
| id | doaj-art-142b0283c4114c679372cd2bc0f5180b |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-142b0283c4114c679372cd2bc0f5180b2025-01-09T12:05:09ZengBMJ Publishing GroupOpen Heart2053-36242025-01-0112110.1136/openhrt-2024-003112Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valveMitsuaki Isobe0Mitsunobu Kitamura1Mamoru Nanasato2Itaru Takamisawa3Ryosuke Higuchi4Makoto Ohno5Sakakibara Heart Institute, Fuchu, Tokyo, JapanDepartment of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, JapanDepartment of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, JapanDepartment of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, JapanDepartment of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, JapanDepartment of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Tokyo, JapanBackground Valve-related haemolysis is a known complication following prosthetic valve surgery. Haemolysis after transcatheter aortic valve implantation (TAVI) has been reported in some studies, all of which were non-critical. Data related to haemolysis associated with new-generation balloon-expandable valve (BEV) are scarce.Methods Among 441 patients who underwent TAVI between April 2023 and June 2024, 282 patients treated with new-generation BEV were analysed. Haemolysis was defined based on the lactate dehydrogenase, haemoglobin, reticulocyte and haptoglobin levels. Clinically relevant haemolysis was defined as a case requiring transfusion and/or reintervention.Results Clinically relevant haemolysis occurred in 6 of 282 patients (2.1%), with median age of 84 years. Three (50%) received a 20 mm valve, and the oversizing ranged from −6.6% to +2.7%. All patients (100%) exhibited paravalvular leakage at the native commissural sites, with moderate or greater paravalvular leakage in two (33%). Lactate dehydrogenase levels exceeded 1200 IU/L in five (83%), four (67%) required transfusion and three (50%) underwent reintervention: balloon aortic valvuloplasty in one and valve-in-valve procedures in two. Haemolysis regressed in three reintervention cases; however, one patient died 9 days postoperatively due to COVID-19. Among three patients (50%) managed conservatively, one developed prosthetic valve endocarditis, whereas another showed spontaneous regression of haemolysis. Over a median follow-up of 218 days, five patients (83%) survived.Conclusion Clinically relevant haemolysis occurred in 2.1% of patients undergoing TAVI with new-generation BEV, with 67% requiring transfusion and 50% undergoing reintervention. Further research is warranted to identify risk factors and optimise management strategies for haemolysis.https://openheart.bmj.com/content/12/1/e003112.full |
| spellingShingle | Mitsuaki Isobe Mitsunobu Kitamura Mamoru Nanasato Itaru Takamisawa Ryosuke Higuchi Makoto Ohno Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve Open Heart |
| title | Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve |
| title_full | Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve |
| title_fullStr | Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve |
| title_full_unstemmed | Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve |
| title_short | Clinically relevant haemolysis after transcatheter aortic valve implantation with new-generation balloon-expandable valve |
| title_sort | clinically relevant haemolysis after transcatheter aortic valve implantation with new generation balloon expandable valve |
| url | https://openheart.bmj.com/content/12/1/e003112.full |
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